P550 Long-term effectiveness of anti-TNF agents in symptomatic stricturing Crohn’s disease
I. Rodríguez-Lago1, J. Del Hoyo2, M.J. Casanova3, A. Fernández-Clotet4, M.J. García5, R. Ferreiro-Iglesias6, M. Piqueras7, C. Suárez8, A. López-García9, M. Arroyo10, M. Sierra11, P. Delgado-Guillena12, I. Guerra13, O. Merino14, L. Arranz15, J. Llaó16, R. Plaza17, G. Molina18, P. Torres19, P. Pérez-Galindo20, C. Herrera-deGuise21, E. Armesto22, F. Mesonero23, U. Aguirre24, J.P. Gisbert25, EFATECS study group from GETECCU
1IBD Unit, Hospital de Galdakao, Biocruces Bizkaia Health Research Network, Gastroenterology, Bilbao, Spain, 2Hospital Universitari i Politècnic La Fe, Gastroenterology, Valencia, Spain, 3Hospital Universitario de La Princesa, Gastroenterology, Instituto de Investigación Sanitaria Princesa IIS-IP, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas CIBERehd, Gastroenterology, Madrid, Spain, 4Hospital Clinic, Gastroenterology, Barcelona, Spain, 5Hospital Universitario Marqués de Valdecilla, Gastroenterology, Santander, Spain, 6Hospital Clínico Universitario de Santiago de Compostela, Gastroenterology, Santiago de Compostela, Spain, 7Consorci Sanitari de Terrassa, Gastroenterology, Terrassa, Spain, 8Hospital Universitario La Paz, Gastroenterology, Madrid, Spain, 9Hospital del Mar, Hospital del Mar Medical Research Institute IMIM, Gastroenterology, Barcelona, Spain, 10IIS Aragón, Hospital Clínico Universitario Lozano Blesa CIBERehd, Gastroenterology, Zaragoza, Spain, 11Complejo Asistencial Universitario de León, Gastroenterology, León, Spain, 12Hospital General de Granollers, Gastroenterology, Granollers, Spain, 13Hospital Universitario de Fuenlabrada, Instituto de Investigación de La Paz IdiPaz, Gastroenterology, Fuenlabrada, Spain, 14Hospital Universitario de Cruces, Hospital Universitario de Cruces, Barakaldo, Spain, 15Hospital Ntra. Sra. Candelaria, Hospital Ntra. Sra. Candelaria, Santa Cruz de Tenerife, Spain, 16Althaia- Xarxa Assistencial Universitària de Manresa, Gastroenterology, Manresa, Spain, 17Hospital Universitario Infanta Leonor, Gastroenterology, Madrid, Spain, 18Complejo Hospitalario Universitario de Ferrol, Gastroenterology, Ferrol, Spain, 19Hospital Universitario German Trias I Pujol-, Gastroenterology, Badalona, Spain, 20Hospital Montecelo, Gastroenterology, Pontevedra, Spain, 21Hospital Universitari Vall d’Hebron, Gastroenterology, Barcelona, Spain, 22Hospital San Agustín, Gastroenterology, Avilés, Spain, 23Hospital Universitario Ramón y Cajal, Gastroenterology, Madrid, Spain, 24Hospital de Galdakao, Research Unit- Red de Investigación en Servicios de Salud en Enfermedades Crónicas REDISSEC, Galdakao, Spain, 25Hospital Universitario de La Princesa Instituto de Investigación Sanitaria Princesa IIS-IP- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas CIBERehd, Gastroenterology, Madrid, Spain
Background
Approximately one half of the patients with Crohn’s disease (CD) develop intestinal strictures during their lifetime. The effectiveness of currently approved drugs in fibrosis-predominant lesions is very limited. Our aim was to determine the effectiveness of anti-TNF therapy in CD complicated by symptomatic intestinal strictures in a real-world setting.
Methods
We included adult patients with symptomatic stricturing CD receiving their first-line anti-TNF therapy. Strictures were defined as constant luminal narrowing with pre-stenotic dilatation. We excluded those patients with previous anti-TNF exposure, surgery or endoscopic therapy of the stenosis. The effectiveness of the anti-TNF was defined as a composite outcome combining the persistence of the treatment and without dose or frequency intensification, with no new immunomodulators, surgery or endoscopic therapy during follow-up. A multivariate Cox regression was performed and the final multivariate model was determined using a backward procedure.
Results
A total of 262 patients from 32 sites were included (141 received infliximab and 121 adalimumab). The median number of stenosis per patient was 1 (range 1–9). The treatment was effective in 81% and 59% of patients after 6 and 12 months, respectively, while this outcome was fulfilled by 21% after a median of 40 months (IQR, 19–85). During follow-up, anti-TNF therapy required a dose or frequency adjustment in 39% of patients, 12% required a new immunomodulator or endoscopic therapy in 4%. The proportion of subjects requiring surgery was 15% and 21% after 1 and 2 years, respectively, with an overall rate of surgery of 32%. Infliximab was associated with a higher rate of surgery as compared with adalimumab (OR 1.78; 95% CI, 1,025-3,09). A shorter time since the diagnosis of CD or the stricture and the initiation of anti-TNF therapy was associated with a greater effectiveness at 6 and 12 months (HR 0.99 95% CI 0.99–1,
Conclusion
Anti-TNF agents are effective in approximately 20% of patients with CD complicated with symptomatic strictures. Early introduction of anti-TNF therapy improves the effectiveness in the short term in these patients. Some clinical and radiological predictors can identify patients with a lower probability of response.